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Original Research

Open Access

Pre- and post-training changes in the test-ordering behavior of the emergency physicians in the management of adults with acute gastroenteritis

  • Sarper Yilmaz1
  • Ozgur Karcioglu2
  • Ozgur Dikme2

1Department of Emergency Medicine, University of Health Sciences, Kartal Dr. Lütfi Kırdar City Hospital, 34862 Kartal, Istanbul, Turkey

2Department of Emergency Medicine, University of Health Sciences, Istanbul Education and Research Hospital, 34098 Fatih, Istanbul, Turkey

DOI: 10.22514/sv.2021.091 Vol.17,Issue 6,November 2021 pp.37-42

Submitted: 26 March 2021 Accepted: 21 April 2021

Published: 08 November 2021

*Corresponding Author(s): Sarper Yilmaz E-mail:


Introduction: The aim of this study is to investigate the education-inflicted changes in the test-ordering behavior of the emergency physicians in the management of patients with a presumptive diagnosis of acute gastroenteritis (AGE).

Methods: The study was designed as a single-center interventional study and was conducted in a large training hospital over a two-month period. In the first month of the study; physicians’ test ordering behavior in patients with acute AGE was analyzed (Group 1). After one-month period, physicians working in the hospital emergency department (ED) underwent a one-hour focused training on the management of patients with AGE. One month after the training, variations in test order habits were observed and recorded (Group 2). Before and after the training; demographic information, vital signs on admission, complaints, physical examination findings, associated conditions, and the work-up results were analyzed comparatively.

Results: Following the education session, there was a decrease of 6% in the rate of tests ordered for the patients and an increase of 11% in the rate of pathological findings on the laboratory work up. The patients’ blood pressure, body temperature and heart rate were the factors without any effect on test-ordering behavior. In the present study, the ratio of patients ordered tests in the management of AGE in the ED was found to be lower and the rate of pathological findings was higher in the post-education period when compared to pre-education period.

Conclusions: Future population-based well-designed studies will enlighten the possible effect of education on test-ordering in acute medicine.


Emergency department; Acute gastroenteritis; Test ordering; Education; Cost-effectiveness

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Sarper Yilmaz,Ozgur Karcioglu,Ozgur Dikme. Pre- and post-training changes in the test-ordering behavior of the emergency physicians in the management of adults with acute gastroenteritis. Signa Vitae. 2021. 17(6);37-42.


[1] Riddle MS, DuPont HL, Connor BA. ACG clinical guideline: diagnosis, treatment, and prevention of acute diarrheal infections in adults. American Journal of Gastroenterology. 2016; 111: 602–622.

[2] Shane AL, Mody RK, Crump JA, Tarr PI, Steiner TS, Kotloff K, et al. 2017 infectious diseases society of america clinical practice guidelines for the diagnosis and management of infectious diarrhea. Clinical Infectious Diseases. 2017; 65: 1963–1973.

[3] World Health Organization, Pan American Health Organization. The World Health report 1996: fighting disease, fostering development. 1996.

[4] Stuart PJ, Crooks S, Porton M. An interventional program for diagnostic testing in the emergency department. Medical Journal of Australia. 2002; 177: 131–134.

[5] Sönmez Ç, Akın Kadir O, Kösem A, et al. Determining unnecessary test requests by comparing the pathological result rates of the tests. 2014. Available at: 2750520/slides/slide_1.jpg (Accessed: 1 May 2021).

[6] Axt-Adam P, van der Wouden JC, van der Does E. Influencing behavior of physicians ordering laboratory tests: a literature study. Medical Care. 1993; 31: 784–794.

[7] Fermann GJ, Suyama J. Point of care testing in the emergency department. Journal of Emergency Medicine. 2002; 22: 393–404.

[8] Hasanali Jafarpoor, Parvaneh Vasli, Houman Manoochehri, Farid Zayeri. Measuring Family-centered Care in Intensive Care Units: Developing and Testing Psychometric Properties. Signa Vitae. 2020; 16: 82-91.

[9] Dashevsky M, Bernstein SL, Barsky CL, Taylor RA. Agreement Between Serum Assays Performed in ED Point-of-Care and Hospital Central Laboratories. West J Emerg Med. 2017; 18: 403–409.

[10] Lee-Lewandrowski E, Corboy D, Lewandrowski K, Sinclair J, McDermot S, Benzer TI. Implementation of a point-of-care satellite laboratory in the emergency department of an academic medical center. Impact on test turnaround time and patient emergency department length of stay. Archives of Pathology Laboratory Medicine. 2003; 127: 456–460.

[11] Guerrant RL, Van Gilder T, Steiner TS, Thielman NM, Slutsker L, Tauxe RV, et al. Practice guidelines for the management of infectious diarrhea. Clinical Infectious Diseases. 2001; 32: 331–351.

[12] Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. ESC Scientific Document Group. European Heart Journal. 2018; 39: 3021–3104.

[13] GL Horowitz, S Altaie, JC Boyd. Defining, establishing, and verifying reference intervals in the clinical laboratory; approved guideline. 3rd edn. CLSI document C28-A3. Wayne, PA: Clinical and Laboratory Standards Institute. 2008.

[14] Solberg HE. International federation of clinical chemistry (IFCC), scientific committee, clinical section, expert panel on theory of reference values, and international committee for standardization in haematology (ICSH), standing committee on reference values. approved recommendation (1986) on the theory of reference values. Part 1. The concept of reference values. Journal of Clinical Chemistry and Clinical Biochemistry. 1987; 25: 337–342.

[15] Bunting PS, van Walraven C. Effect of a controlled feedback intervention on laboratory test ordering by community physicians. Clinical Chemistry. 2004; 50: 321–326.

[16] Tiryaki Ö. Evaluation of management and antimicrobial therapy of patients admitted due to diarrhea in the emergency department, Dokuz Eylül University Hospital, Izmir, TURKEY. Thesis Study. 2005. (In Turkish)

[17] Sarıyer G, Ataman MG, Kızıloğlu İ. Factors affecting length of stay in the emergency department: a research from an operational viewpoınt. International Journal of Healthcare Management. 2020; 13: 173–182.

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